HomeMy WebLinkAbout2375 . .
. D~:ci~~rati~n ot Ao~nicile ant~ Citizcn~~~ip
t0 THE STATE AND COUNTY TAX ASSESSOR, ~
51. lUC1E GOUNTY, FIORIDA: • 251595
This ~s my declaratio~ of ~omicile a~d Citizenship in the State of Florida that 1 am filing this day in atto~dante and
in conformity with Chapter 222, Scttion 222.17, Florida Statutes.
1 was fomnerly a legal resident of _ ~1~~~ ~1~ ~ d~ 1~ ~
(City) (State)
end 1 ~esided at ~`'°2 U~ E~~~• . However 1 have changed my domicjle
~ (Street and Numbe~) -
to end am and have been a bona fide resident of the State of Florida since ,3 day of
, 19 , and 1 reside ~at ' ~~'S'~
~ ~ ~ .
~ (Street and Number)
~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida.
. qnse~t here any peninent facts. such as sale of propery or business, or relinquishment of employment
at fwmer domicile, removai of family to new domicile, purchase of home, etc.) ' -
Applying, for Homestead ~ .
- Entering children fn school : ~
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CLE KCCIRCUIT C URT ~
RECORp VERtF1E0.,~,~~
A~ 9 I oz PM'13
~ ~ 25i595 ~ .
I FURTHER CERTIFY that 1 will compty with all other requirements of a legal residenfi of fhis State.
1 FURTHER CERTIFl( that 1 have no intention to return to my former domi~ile, and 1 intend to remain in FORT
PIERCE,~S~JJ;~j~
ltlCIE~;COUNTY, FLOR(DA, pe~manently. "
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Sworn'to and subscribed before me this ay of , 1q
_ .
ROGER POITRAS -
CLERK CIRCUIT COURT Notary Public ,
~
~
4Y ~ D.C. My ~ommission expires
ao~212 ~~2375
(To be oxeculod in duplicsle and original fi{od with Glork Circuil Courf, and duplicats with TaX Atsessor.~
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